Renal denervation, a last resort for patients with resistant hypertension

This study aimed to highlight the factors involved in eligibility for renal denervation in patients with resistant hypertension.

Resistant hypertension is high blood pressure that does not lower when treated with standard medications. Methods for treating resistant hypertension include spironolactone (Aldactone). However, spironolactone does not work in all cases. Renal denervation may be considered in patients who do not respond to spironolactone.

Renal denervation (RDN) is a relatively new procedure that reduces certain nerve impulses to the kidney that are involved in the development of hypertension. There are many serious side effects associated with RDN, such as damage to the arteries of the kidney. The decrease in blood pressure may not be as large as hoped for. Also, the long-term effects of renal denervation are unknown. For these reasons RDN should only be a last resort in certain patients with resistant hypertension.

The current study aimed to determine which patients with resistant hypertension were or were not appropriate for RDN. 

This study examined 731 resistant hypertension patients referred to specialists for their eligibility for RDN.  At the start of the study the average blood pressure was 176/96 mmHg. Up to 27.2% of patients had not exhausted the treatment options for resistant hypertension.

Approximately 42.5% of patients were eligible for RDN. The main reason for ineligibility was that all other treatments options had not been exhausted. Blood pressure was lowered in 47% of patients after treatment adjustment by blood pressure specialists, including the addition of spironolactone. In some patients, the shape of the renal artery wasn't appropriate for the procedure. 

Patients who were found to be eligible had been treated with a higher number of medications or had higher and more variable blood pressures than those who were not eligible. 

This study concluded that RDN should be considered only after all other treatments have been attempted. 

If you are struggling with resistant hypertension, discuss with your physician whether or not other medications may be of use.